Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, CHU Grenoble-Alpes, Grenoble, France; Grenoble-Alpes University, Grenoble, France.
Department of Nephrology and Clinical Immunology, CHU Tours, Tours, France.
Transplant Proc. 2020 Dec;52(10):3179-3185. doi: 10.1016/j.transproceed.2020.06.005. Epub 2020 Jul 5.
Kidney transplant recipients (KTRs) are frequently infected with chronic hepatitis C virus (HCV), which can increase the risk of graft loss. Active HCV infections among KTRs are associated with shorter survival times. The emergence of very efficient interferon-free treatments (direct-acting antivirals [DAAs]) has revolutionized prognoses for chronic viral hepatitis. We performed a multicenter study where HCV (+)/RNA (+) KTRs were followed up and either received DAAs (group A) or not (group B) according to the transplant center. The aim was to assess, in a real-life setting, the impact of DAA therapy and to compare these results with those from HCV RNA (+) KTRs where HCV infection was not treated during the same period.
This study included 66 patients from 11 centers: 44 patients (66.7%; group A) received DAAs, whereas 22 patients did not (group B); the 2 groups were comparable according to baseline data. Most patients (88.6%) received sofosbuvir, 50% received ledipasvir, and 34.7% received daclatasvir. The duration of treatments ranged from 8 to 24 weeks.
HCV RNA clearance (ie, a sustained virologic response) was observed in 95.4% of treated patients. Eradication of HCV led to a significant decrease in liver enzymes (50% reduction for alanine aminotransferase [P ≤ .001] and 41% for gamma glutamyl transpeptidase [P < .001]). Conversely, liver enzymes did not decrease in group B. Death occurred significantly more frequently in nontreated than treated patients (3 in group B vs none in group A, P = .003). Of the 10 treated patients with severe renal impairment before DAA therapy, 6 experienced graft loss.
DAAs are very effective at treating chronic HCV and have an excellent tolerance profile.
肾移植受者（KTR）经常感染慢性丙型肝炎病毒（HCV），这会增加移植物丢失的风险。KTR 中的活动性 HCV 感染与较短的生存时间有关。非常有效的无干扰素治疗（直接作用抗病毒药物 [DAA]）的出现彻底改变了慢性病毒性肝炎的预后。我们进行了一项多中心研究，对 HCV（+）/RNA（+）KTR 进行了随访，并根据移植中心对其进行 DAA 治疗（A 组）或不治疗（B 组）。目的是在真实环境中评估 DAA 治疗的影响，并将这些结果与同期未治疗 HCV RNA（+）KTR 的结果进行比较。
这项研究纳入了来自 11 个中心的 66 名患者：44 名患者（66.7%；A 组）接受了 DAA 治疗，而 22 名患者未接受（B 组）；两组根据基线数据具有可比性。大多数患者（88.6%）接受了索磷布韦治疗，50%接受了来迪派韦治疗，34.7%接受了达卡他韦治疗。治疗持续时间为 8-24 周。
95.4%接受治疗的患者 HCV RNA 清除（即持续病毒学应答）。HCV 消除导致肝酶显著降低（丙氨酸氨基转移酶降低 50%[P≤0.001]，γ-谷氨酰转肽酶降低 41%[P<0.001]）。相反，B 组的肝酶没有降低。未治疗的患者比治疗的患者死亡频率显著更高（B 组 3 例，A 组无死亡，P=0.003）。在接受 DAA 治疗前患有严重肾功能不全的 10 名治疗患者中，有 6 名患者发生移植物丢失。
DAA 治疗慢性 HCV 非常有效，且具有良好的耐受性。
